NYC 9/11 Public Portal Document
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUR AU OF ENVIRONMENTAL COMPLIANCE
ASBESTOS AND LEAD CONTROL PROGRAM
59-17 JUNCTION BOULEVARD
CORONA, NY 11368
JOEL A. MIEtL SRJL
COMMISSIONEI
BULK
ANALYSIS CHAIN OF CUSTODY
Incident No.: Date Sampled:221f- f Z
Premise: /i7 W A-F-R E AJ SSE i Boro: /A' V/M77ThV
Time: J S 510 ant
Inspector. Q I R }' 11P WAW
Print Signature
Turnaround Time: Immediate 1 "1 24 Hours 1 I 48 Hours 1 I I Week I I
SAMPLE NUMBER I DESCRIPTION I WCATION SAMPLED LAB 1D
1.2O2 Ao770o1
2. 2 Z4 JA7787V2- Pi Js r
3. 20 2- Ao7 90V3 r v
4. 20 /.o7RovIIC q a
S. 2022-Lf A-7f QDs n n
6. 2oZ A-o -7toV6 ~
7. 20 2-Z- 4A A(o;rR o o7 4 „ Qo
¢
8. 2o22 -I, AP7 QD
9. Zo 2- .4 . /4" 7br 0V-7 f— K :nI rk
10.
ANALYSIS REQUESTED: Asbestos PLM Iii Asbestos TEM I I Lead I I
Date Time Accepted By Comments
I• am Print
pm
Sign
2. am Print
pm
Sign
3. am Print
pm
Sign
4. am Print
pm
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S. am Print
pm
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NYC-WTC 000112674
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